C-Suite Cheet Sheat: Medicare Part B

Educational briefing for suppliers and service providers

Executive summary

Medicare Part B, commonly referred to as Medicare medical insurance, covers a range of services and supplies, including preventative care, lab tests, outpatient prescription drugs, and durable medical equipment. These services can be furnished in a variety of outpatient care settings. Like commercial insurance enrollees, Medicare Part B enrollees must pay a monthly premium and are subject to an annual deductible and a coinsurance rate (typically around 20%).

Medicare reimburses providers for Part B services based on annual fee schedules, updated each year. Notably, the Medicare Access and CHIP Reauthorization Act (MACRA) repealed the previous formula used for updating the Medicare Physician Fee Schedule (PFS) and created the Quality Payment Program (QPP). As the result of MACRA, beginning in 2019 many providers will face payment adjustments based on their ability to deliver high-quality, cost-efficient patient care; however, some clinicians will be exempt from MACRA and will continue to receive payment under the traditional fee-for-service (FFS) model.

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